title: Predicting aortic complications after endovascular aneurysm repair.
abstract: BACKGROUND
  Lifelong surveillance is standard after endovascular repair of abdominal aortic aneurysm (EVAR), but remains costly, heterogeneous and poorly calibrated. This study aimed to develop and validate a scoring system for aortic complications after EVAR, informing rationalized surveillance.
  
  
  METHODS
  Patients undergoing EVAR at two centres were studied from 2004 to 2010. Preoperative morphology was quantified using three-dimensional computed tomography according to a validated protocol, by investigators blinded to outcomes. Proportional hazards modelling was used to identify factors predicting aortic complications at the first centre, and thereby derive a risk score. Sidak tests between risk quartiles dichotomized patients to low- or high-risk groups. Aortic complications were reported by Kaplan-Meier analysis and risk groups were compared by log rank test. External validation was by comparison of aortic complications between risk groups at the second centre.
  
  
  RESULTS
  Some 761 patients, with a median age of 75 (interquartile range 70-80) years, underwent EVAR. Median follow-up was 36 (range 11-94) months. Physiological variables were not associated with aortic complications. A morphological risk score incorporating maximum aneurysm diameter (P < 0·001) and largest common iliac diameter (measured 10 mm from the internal iliac origin; P = 0·004) allocated 75 per cent of patients to a low-risk group, with excellent discrimination between 5-year rates of aortic complication in low- and high-risk groups at both centres (centre 1: 12 versus 31 per cent, P < 0·001; centre 2: 12 versus 45 per cent, P = 0·002).
  
  
  CONCLUSIONS
  The risk score uses commonly available morphological data to stratify the rate of complications after EVAR. The proposals for rationalized surveillance could provide clinical and economic benefits.
authors.affiliation: St George’s Vascular Institute, Room 4.007, St George’s Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK. akarthik@sgul.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.forename: A
authors.initials: A
authors.lastname: Vidal-Diez
authors.forename: E C
authors.initials: EC
authors.lastname: Choke
authors.forename: B O
authors.initials: BO
authors.lastname: Patterson
authors.forename: L J
authors.initials: LJ
authors.lastname: Thompson
authors.forename: T
authors.initials: T
authors.lastname: Ghatwary
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000601:surgery*; D057867:Endoleak / Q000209:etiology / Q000473:pathology; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D017543:Iliac Aneurysm / Q000473:pathology; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment / Q000379:methods; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000209:etiology / Q000473:pathology